New Hire Form

Fill this form out only if you have been hired by R&R Reinforcing.

12%

First Name*
Middle Name*
- I don't have a middle name
Last Name*
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Do you have a Driver's License?*
- Yes
- No
Driver's License State*
Driver's License Number*
Do you have a reliable form of transportation?*
- Yes
- No
Current Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email Address*
What locations are you available to work? (check all that apply)*
- Washington DC/Metro
- Tidewater VA
- Central VA
- New York
Work Experience
Employer Name Position Start Date - End Date (M/Y) Reason for leaving
Other References
Name Relationship Telephone
Have you ever been convicted of a felony?*
- No
- Yes
Note: Being convicted of a felony does not exclude you from being hired.
Felony Convictions*
Felony Name Conviction Date Prison (Y/N) Start Date - End Date (M/Y)
Description of all felonies listed above*

Direct Deposit*
- I certify that this is not a shared account (other than with a spouse)
Name on Account*
Routing Number*
Account Number*

Applicants must upload color images of any requested documents.
Citizen Status*
- I am a U.S. Born Citizen
- I am a Naturalized U.S. Citizen
- I am not a U.S. Citizen
Driver's License*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.
Social Security Card*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.
Birth Certificate*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.
Do you have a Passport?*
- Yes
- No
Passport*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.
Naturalization Certificate*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.
Resident Alien Card*
Accepted file types: jpg, jpeg, gif, png, Max. file size: 2 GB.

USCIS Form I-9
You are required to fill out an actual printed form that fill be provided to you prior to starting work. Please refer to the actual printed I-9 form for instructions.

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
I attest, under penalty of perjury, that I am*
- A citizen of the United States
- A noncitizen national of the United States
- A lawful permanent resident (Alien Registration Number/USCIS Number)
- An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:
I will provide my*
- Alien Registration Number/USCIS Number
- Form I-94 Admission Number
Alien Registration Number/USCIS Number*
Form I-94 Admission Number*
If you obtained your admission number from CBP in connection with your arrival in the United States, include the following:
Foreign Passport Number
Country of Issuance

Form W-4
You are required to fill out an actual printed form that fill be provided to you prior to starting work. Please refer to the actual printed W-4 form for instructions and worksheet to determine your answers.
Choose one*
- Single
- Married
- Marrield, but withhold at higher Single rate
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
Enter your answer from Line 5 from the W-4 form*
Enter your answer from Line 6 from the W-4 form*
Enter your answer from Line 7 from the W-4 form
- Exempt

Form VA-4
You are required to fill out an actual printed form that fill be provided to you prior to starting work. Please refer to the actual printed VA-4 form for instructions and worksheet to determine your answers.
Enter your answer from Line 8 from the VA-4 form*
I understand that in the event that I am INJURED on the job, I am to immediately report it to my supervisor. I will fill out the accident report and return it to my supervisor within 24 hours. If I do not comply, I fully understand that I will be solely responsible for ALL medical bills incurred from the accident.*
- I understand

- I certify that all of the information provided is to the best of my knowledge and belief true, correct and complete.
Signature*
Name
This field is for validation purposes and should be left unchanged.

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(540) 545-8315
P.O. Box 4397
Winchester, Virginia 22604

R&R Reinforcing, Inc. is always on the lookout for intelligent new employees.

Employer Name	Position	Start Date - End Date (M/Y)	Reason for leaving

Name	Relationship	Telephone

Felony Name	Conviction Date	Prison (Y/N)	Start Date - End Date (M/Y)